Drinking Alcohol and Heart Disease - Facts and Information

Every cigarette has the potential to do the heart
harm. Is the same true of alcohol?

That is very difficult to answer. First, it has to
be conceded that there is no evidence to link moderate amounts of alcohol with
heart disease. Alcohol tends to open up arteries, rather than close them, so
some doctors have even argued that a little alcohol may do 'heart' patients
good.

However, it all depends on what is meant by a ‘little',
and on whether the drinker can stick to the rules. A little can so easily
become a lot!

Probably the group of doctors to have done most to
investigate the effects and ill-effects of measured amounts of alcohol are the
team led by Professor Roger Williams, of the Liver Unit at London's
King's CollegeHospital. Over many years they have
studied the drinking habits of thousands of people, and they have finally come
to definite conclusions, which are now used as standards for the guidance of
doctors all over the world.

Classically, doctors have been taught that the main
organs attacked by alcohol are the liver and the brain. Too much alcohol causes
cirrhosis and even cancer of the liver, and can damage the brain cells, leading
to loss of intellect and even insanity.

So how much is too much? The King's College team
has defined that very clearly. They talk of standard 'units' of alcohol. One
unit is equivalent to a half pint (500 ml) of beer or lager, one glass of wine,
one measure of fortified wines such as sherry or martini, and a single measure
of spirit such as whisky or gin (a half measure in Scotland).

Men, according to the experts, can cope with up to
21 standard units of drink a week. For women the upper weekly limit is only 14
units. (The difference is not just due to their difference in size: it also
arises from the need for the liver in women to cope with their sex hormones as
well as the alcohol.)

This means that the regular male drinker should
take no more than three drinks, and his female counterpart no more than two
drinks, on any night. However, even this may be too much, if the drinking goes
on every night. Professor Williams' team advise that the body should be given a
rest from alcohol on at least three days a week.

This advice was originally given to help people
avoid liver and brain damage, but it is now becoming clear that it holds good
for the heart, too.

There is nothing to suggest that alcohol in excess
helps to cause heart attacks, in the sense that it might narrow the coronary
arteries, accelerate atheroma or make the blood more viscous. It does not
increase the blood's tendency to clot. It may even open up blood vessels a
little - this is the cause of an alcoholic flush. So, superficially, alcohol
could be said to help, rather than promote heart attacks. This, in fact, used
to be the advice given by some doctors. They suggested to patients who already
had heart disease that 'a little drink every now and then' might do good.

Unfortunately that advice is wrong! The proof of
that was given by Dr Gareth Beevers, of DudleyRoadHospital,
Birmingham. Dr
Beevers is an internationally known specialist in hypertension (high blood
pressure). A review of thousands of patients with hypertension established a
very strong fink between alcohol consumption and high blood pressure: the more
people drank, the higher the pressure.

This surprised many doctors, who felt that alcohol
might if anything lower the pressure. Dr Beevers proved, however, that alcohol
had a special, direct effect on the heart, even when taken in moderate doses.
Many moderate drinkers had enlarged hearts, high blood pressure and a poor
heart reserve in times of crisis.

The conclusion had to be that if you are a drinker,
and have a heart problem, such as angina or a full blown heart attack, then the
alcohol will always make that worse, rather than better. For the person with
angina it is probably better to be teetotal than to take alcohol as a
'stimulant'. In fact, Dr Beevers' work suggested that alcohol may appear to the
drinker to be a stimulant, but it is in fact a depressant.

So how much can one drink without causing harm? For
people who are healthy, and obey all the rules, such as not smoking, exercising
well, eating correctly, and who do not have high blood pressure or diabetes,
then the King's College figures apply. They can drink up to two or three units
per day, perhaps four times a week.

For the person with high blood pressure or angina,
or who has had a previous heart attack, then this may be too much. Where
alcohol is concerned, each case should be taken on its merits. My advice is, if
you are in one of these categories, that you should talk over your drinking
habits very carefully, and honestly, with your specialist.

Looking back on Dr Beevers' work from the vantage
point of the year 2000, it seems that opinions on alcohol vary from time to
time, but the underlying message remains the same. Today's accepted opinion is
that people who drink a little are a little less likely to have heart attacks
and strokes than those who drink no alcohol at all. And they are a lot less
likely to have them than people who drink more than the standard three drinks a
day for men and two drinks a day for women. However, this article is
meant for people who already have heart problems: these risk statistics refer
to people in normal health. Interestingly they come from population studies in Bordeaux (home of red wine), Munich
(home of beer) and Edinburgh
(home of whisky). There is no evidence that alcohol is beneficial to people -
whose hearts are already at risk, and it may be harmful. So the advice remains,
drink only in moderation.

A last word about alcohol. Probably the busiest
days of the year for family doctors are those immediately after a national
feast day or holiday. I'm thinking of Christmas in England,
or New Year's Day in Scotland
- or of special occasions, like a reunion or anniversary party. It is at times
like these that people overeat - usually a meal full of animal fats - and over
drink as well. The inhibitions are down, everyone is merry, and they go to bed
full of food and drink.

During the night, all the conditions for shutting
off a blood vessel in the brain or the heart are fulfilled - the fat in the
bloodstream makes the blood flow more sluggish, the blood's tendency to clot
will rise, the strain on that little plaque of atheroma will be that little bit
greater, and the alcohol will have raised the blood pressure that little bit
further. The result, in susceptible people, is the heart attack or stroke in
the small morning hours.

I hate to be a killjoy, but if you have taken the
trouble to change your lifestyle to protect your heart, it is a great pity to
throw it away just because of one night of overindulgence. You can enjoy a
party without overeating and drinking too much, and think of how much better
you will feel in the morning!

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